Long-term Outcome of Infants with Spina Bifida Through Assessment of the Prognostic Value of Hostile Bladder Parameters

INTRODUCTION: In 2016, the Centers for Disease Control and Prevention (CDC) published a management algorithm for spina bifida (SB) cases from birth and started collecting data prospectively. They designated risk factors from urodynamic studies as end filling pressure or detrusor leak point pressure (DLPP) ≥40 cmH2O or neurogenic detrusor overactivity (NDO) with detrusor sphincter dyssynergia (DSD), and named this type of bladder dysfunction as “hostile bladder” (HB). They recommended the immediate start of clean intermittent catheterization and anticholinergics in these patients. Having similar concerns on this patient population, we designed a retrospective study to identify and reveal long-term outcomes of SB patients with HB.
METHODS: All urodynamic studies and hospital records of SB patients admitted and followed between 1994-2014 were reviewed retrospectively. The demographic data, the presence of DLPP, DSD and NDO in the first urodynamic examination, bladder compliance, first and last radiologic and scintigraphic imagings, surgical interventions were evaluated. Upper tract damage was defined as new scars in DMSA scans.
RESULTS: A total of 58 patients were included in the study. The mean follow-up was 12.17±5.17 years. The presence of a scar in the first scintigraphy (p=0.01) and the presence of hydronephrosis in the first and last ultrasonography (p=0.03) were found to be independent risk factors for new scar development. When DLPP values were evaluated with ROC analysis, 50cmH2O was observed as a significant threshold value with 73% sensitivity and 60% specificity.
DISCUSSION AND CONCLUSION: Our study confirmed the detrimental effects of high pressure and detrusor-sphincter dyssynergia; however, hostile bladder parameters were not sufficient to distinguish high-risk group patients. The presence of scars in the first scintigraphic evaluation, DLPP above 50cmH2O, and the presence of hydronephrosis in the first ultrasound were found to be risk factors for renal deterioration. More frequent monitoring and detailed evaluation may be necessary for patients with these risk factors.